Weight Loss Supplements

Robert Saper, director of Integrative Medicine at Boston University School of Medicine, was online Tuesday, Dec. 13, at 11 a.m. ET to field questions and comments about dietary supplements for weight loss.

From The Post:

Pills for Losers (Post, Dec. 13)

Graphic: Common Supplements

Ephedra: It's Back! Sort of (Post, Dec. 13)

Saper is a member of Boston University Medical Center's Family Medicine Department's research faculty. His interests are to develop research, educational, and clinical programs that explore how complementary and alternative therapies can be responsibly integrated with conventional medicine. Prior to joining BUMC, he completed a three year Complementary Medicine Research Fellowship at Harvard Medical School. He currently is developing a curriculum in complementary medicine for BUMC's residency program. Saper graduated from Harvard Medical School in 1988. After completing a family medicine residency at UCSF, he practiced in the San Francisco Bay Area for 8 years.

The Transcript follows.

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Columbia, S.C.: Do overweight people tend to eat more nutritionally deficient foods (i.e. white bread, pasta)?

Which nutritional supplements curb cravings for nutritionally deficient foods?

Robert Saper, MD, MPH: Hello,

It does often occur. Many people with abdominal obesity eat a great deal of "white carb" eg bread and pasta which do not have a great deal of vitamins and minerals. Moving to a diet with more lean protein, increased fiber will decrease these cravings. There is some evidence that chromium picolinate 200 mcg daily may be of help too.

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Washington, D.C.: Are products like Trim Spa OK to take. I'm slightly over weight and trying to loose about 10 to 15 pounds. I've changed some of my eating habits, and have started w/mild workouts. Does Trim Spa help w/the aid of weight loss, or should I stay away from products like these?

Robert Saper, MD, MPH: Hello

I would discourage it. There are several trimspa's but the X32 contains:

Citrus Naringin which has compounds similar to ephedra, which have been linked with high blood pressure, palpitations, even heart attack and death.

houdia- there is really is no substantial evidence supporting its efficacy

Glucosamine - no evidence for weight loss

This supplement has got a lot of hype that in my opinion is not supported by good data.

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Charlotte, NC: Virtually every weight loss product advertisement contains some version of the line noting its effectiveness when combined with healthy eating and exercise. Of course, healthy eating and exercise by themselves are effective and the supplements could be doing nothing at all. I want to ask you about two possible psychological effects. It's possible that people taking a weigh loss product end up eating the same, or more, because they think the magic pill will make the weight disappear.Almost equally likely, I suspect, is a placebo effect where people on a weigh loss supplement decide they feel more energetic and disposed to exercise, and feel less hungry, when actually it's all in their heads. The first group would end up gaining weight, the second losing. Do you know of any studies that look at these potential effects? Is one more likely to occur than the other?

Robert Saper, MD, MPH: That's an excellent point that you're raising, i.e. placebo ( a positive benefit) or a nocebo effect ( a negative result). Both are possible theoretically. Double blind placebo controlled trials of various weight loss products almost always show that the placebo group also lose weight! Ted Kaptchuk is an investigator at Harvard Medical School who has written extensively on placebo effect. I would recommend doing a pub med search on him (www.pubmed.com)

Best,

Rob Saper

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Baltimore, Md.: I lost 28 lbs last year through diet and excercise. I am having problems losing the last 15 I want to lose. Almost all my fat is around my stomach and waist. I am considering liposuction to help get rid of this stubborn weight. I feel my metabolism slows when I try to lose this weight and exercise doesn't help because I am just too fatigued it seems to do it, whereas when I had the extra lbs before I had energy.

My question is, if I lose those fat cells to liposuction, will this help?

Robert Saper, MD, MPH: First, congratulations on losing the 28 lbs! It is difficult to lose that remaining amount. My recommendations would be to first calculate your Body Mass Index (weight in kg squared divided by height in meters). There are calculators for this on the web. This will help guide your next step. Liposuction would certainly reduce the cosmetic aspect, but not effect your metabolism. I would recommend seeing a certified nutritionist before your next steps, as well as discussing with your MD

Best,

Rob Saper

Good luck

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Washington, D.C.: Are the popular fat burning supplements better suited for people who are fairly active and want to lose the 'last few pounds', as opposed to sedentary and/or obese people? My guess is the former would benefit more.

Robert Saper, MD, MPH: Which supplements specifically are you referring to? CLA, carnitine? If so, there is some modest evidence that they help reduce body fat mass but not total body weight. I do not think they are terribly effective with either active or sedentary people.

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Washington, D.C.: There is a "doctor recommended" LeanLife-PM that claims to burn fat and suppress appetite while you sleep. Is this possible? With diet and exercise, can this help at all? Are the ingredients safe: Apple pectin, ginger root, garcinia cambogia, bromelain, citrus aurantium, willow bark and cayenne?

Robert Saper, MD, MPH: I'll run down the ingredients

Apple pectin - essentially sugar

ginger root - good for nausea but not tested for weight loss

garcinia cambogia - aka HCA, equivocal studies, some showing benefit and some not

bromelain - purported anti inflammatory, not studied for weight loss

citrus aurantium - as I wrote to another person, related to ephedra compounds.

willow bark - the botanical basis of aspirin. In studies of ephedra, aspirin and caffeine + ephedra does lead to weight loss more than placebo, but with 2-3 times the side effects, some of which can be extremely serious or even fatal. With dietary supplements, safety issues need to trump efficacy issues.

To summarize, my answer is no (sorry!)

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Formula studies?: With the rise of obesity in youngsters, is anyone looking into infant formula's for possible links? I see such a difference between the weight of breastfed children and those who were formula fed. The formula babies seem to have less muscle tone, more fat, even after they pass through toddlerhood. Could the popular formulas be 'too nutritious' in their content leading to overweight among the very young?

Robert Saper, MD, MPH: This is a fascinating question. I went to Pubmed.com, which is the free database of all medical articles published since 1966 at pubmed and did a search and this is the review article I found just published in May. It shows that adult obesity is less in breast fed infants. See below:

Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence.

Pediatrics. 2005 May;115(5):1367-77.

Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG.

Department of Community Health Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, United Kingdom. c.owen@sghms.ac.uk

OBJECTIVE: To examine the influence of initial infant feeding on obesity in later life. METHODS: A systematic review of published studies investigating the association between infant feeding and a measure of obesity was performed with Medline (1966 onward) and Embase (1980 onward) databases, supplemented with manual searches. Data extraction was conducted by 2 authors. Analyses were based on odds ratios of obesity among initially breastfed subjects, compared with formula-fed subjects, pooled with fixed-effects models.RESULTS: Sixty-one studies reported on the relationship of infant feeding to a measure of obesity in later life; of these, 28 (298900 subjects) provided odds ratio estimates. In these studies, breastfeeding was associated with a reduced risk of obesity, compared with formula feeding (odds ratio: 0.87; 95% confidence interval [CI]: 0.85-0.89). The inverse association between breastfeeding and obesity was particularly strong in 11 small studies of <500 subjects (odds ratio: 0.43; 95% CI: 0.33-0.55) but was still apparent in larger studies of> or =500 subjects (odds ratio: 0.88; 95% CI: 0.85-0.90). In 6 studies that adjusted for all 3 major potential confounding factors (parental obesity, maternal smoking, and social class), the inverse association was reduced markedly (from an odds ratio of 0.86 to 0.93) but not abolished. A sensitivity analysis examining the potential impact of the results of 33 published studies (12505 subjects) that did not provide odds ratios(mostly reporting no relationship between breastfeeding and obesity) showed little effect on the results. CONCLUSIONS: Initial breastfeeding protects against obesity in later life. However, a further review including large unpublished studies exploring the effect of confounding factors in more detail is needed.

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Arlington, Va.: Are there any weight/fat losing products that are good for people (with exercise of course)?

Robert Saper, MD, MPH: There are some supplements that are certainly safe, or maybe even helpful for non obesity medical issues, but there are none that I currently believe have robust scientific evidence for me as a physician to proactively recommend for my patients. Glucomannan shows some evidence for efficacy. For example, green tea may have very beneficial health effects but has not been shown to lead to weight loss.

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Washington, D.C.: With all the hype and millions of dollars surrounding the weight loss craze, why don't the federal regulators simply put out the skinny on weight loss rather than re-introducing more supplements?

The burning of more daily calories thru activities than what is taken in daily = successful weight loss. Why not inform the public to decrease their caloric intake by 300 k/cal per day and watch for the results naturally?

Sherman W., CPFT, CSNS, CSCS

Robert Saper, MD, MPH: I couldn't agree further! The answer in my opinion is more political and economic than medical. There are tremendously powerful lobbying groups that represent supplement manufacturers in certain states (eg Utah) that have influence on law makers. Also, the FDA and FTC have made some strides on removing some of the products from the market that have made the most extreme claims, but that still leaves a lot to be done. Currently these products are governed by the Dietary Supplement Health and Education Act passed by Congress in 1994 which does not require supplement manufacturers to test for safety or effectiveness prior to marketing! This has to change for any utility to come out of supplements.

Re: informing the public re reducing calories, they are trying, but often less with confusing results - see the new "food pyramid" published by the UDSA - very confusing. I recommend the Walter Willet pyramid from Harvard, that can be read about in his book "Eat, Drink and Be Healthy"

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Washington, D.C.: The weight loss pill that Anna Nicole Smith took has a few different variations, what is the difference between them and what is the risk to a person's health if taken correctly with diet and exercise?

Robert Saper, MD, MPH: Hi. It's trim spa - Please see my comment on it previously. There are different variations:

The lipo sap has chitosan and vitamin C. For chitosan to truly cause weight loss, you would have to eat several pounds of it per day!! not 500 mg.

Chitosan causes minute clinically insignificant weight loss.

Carb blocker has white kidney bean extract. This is purported to inhibit amylase, an enzyme in the gut that breaks down starch. There is one preliminary study that shows after 8 weeks the bean extract group lost about 2 lbs more over 2 months than placebo, a small but possibly meaningful difference. It appears safe. See below for the study abstract, again found on pubmed and also through natural medicines database (www.naturalmedicines.com)

Blocking carbohydrate absorption and weight loss: a clinical trial using Phase 2 brand proprietary fractionated white bean extract.

Udani J, Hardy M, Madsen DC.

UCLA School of Medicine, Integrative Medicine Program, Northridge Hospital, 8250 Roscoe Blvd, Suite 240, Northridge, CA 91325, USA. Jay.Udani@CHW.edu

Background: Phase 2' starch neutralizer brand bean extract product ("Phase 2") is a water-extract of a common white bean (Phaseolus vulgaris) that has been shown in vitro to inhibit the digestive enzyme alpha-amylase.Inhibiting this enzyme may prevent the digestion of complex carbohydrates, thus decreasing the number of carbohydrate calories absorbed and potentially promoting weight loss. Methods: Fifty obese adults were screened to participate in a randomized, double-blind, placebo-controlled study evaluating the effects of treatment with Phase 2 versus placebo on weight loss. Participants were randomized to receive either 1500 mg Phase 2 or an identical placebo twice daily with meals. The active study period was eight weeks. Thirty-nine subjects completed the initial screening process and 27 subjects completed the study. Results: The results after eight weeks demonstrated the Phase 2 group lost an average of 3.79 lbs (average of 0.47 lb per week) compared with the placebo group, which lost an average of 1.65 lbs (average of 0.21 lb per week), representing a difference of 129 percent (p=0.35). Triglyceride levels in the Phase 2 group were reduced an average of 26.3 mg/dL,more than three times greater a reduction than observed in the placebo group (8.2 mg/dL) (p=0.07). No adverse events during the study were attributed to the study medication. Conclusion: Clinical trends were identified for weight loss and a decrease in triglycerides, although statistical significance was not reached. Phase 2 shows potential promise as an adjunct therapy in the treatment of obesity and hypertriglyceridemia and further studies with larger numbers of subjects are warranted to conclusively demonstrate effectiveness.

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Rockville, Md.: I am fascinated by the bad press that milk and orange juice (no sugar added) have among parents. I keep thinking that these two, and of course lots of water, are the best possible drinks for children and teenagers, and should be the only drinks available at school cafeterias. What do you think?

Robert Saper, MD, MPH: What I most agree with you is that for kids, the high use of sugar-containing beverages (sodas, fruit juices, gatorade etc) contribute substantially to our obesity problem in kids. These products are often easily available in the school cafeterias. Hidden sources of sugar (eg 'high fructose corn syrup') often are used.

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Washington, D.C.: What are your thoughts on senna, an ingredient comment in "diet teas"? I have found information which suggests long-term use of senna and its many derivations can be harmful. However, I have friends who swear by it as a compliment to the mainstays of cutting calories and exercising more. As a long distance runner, I tried it for a very brief time and found that while using it (drinking the tea at night, before bed) I no longer had the energy reserves to complete any run over 4-6 miles. Is this a common complaint of senna users?

Robert Saper, MD, MPH: I strongly discourage patients from using senna for weight loss. It is a powerful laxative that can be used rarely (eg 1x/week max) for chronic constipation. With chronic use, important electrolytes such as bicarbonate, chloride, and potassium can get lost through the stool and lead to weakness, etc.

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NEW JERSEY: I am 21 and want to loose about 30 pounds. I do not eat poorly and I am moderately active. Even when I took up a strict six day a week gym schedule for tree months I was only able to loose about 3 pounds. My trainer told me that taking a supplement with Ephedra would help but have no harmful effects. I wanted to know what you think about this.

Also, do you believe that Leptoprin could be of some use to me?

Robert Saper, MD, MPH: Certainly do not take ephedra. Some of the serious case reports on ephedra were in patients without any preexisting risk factors for heart problems and taking recommended doses. I would recommend seeing a nutritionist to carefully review your diet. Are you getting adequate aerobic exercise. Exercise has 3 major components: aerobic, strength, and flexibility. We need a balance of all 3.

Leptoprin has:

calcium - no effect of weight loss

vit b 6 no effect

aspirin: no effect

green tea - see previous comments

l tyrosine and kelp (source of iodine) may support thyroid function, but it has been shown that increasing thyroid levels does not lead to weight loss (and can be harmful).

If you're interested in a comprehensive review of most common weight loss supplements, try to get a copy of a review article I wrote in the Nov 1 2004 American Family Physician Vol 70 p 17311738, available through the publisher at http://www.aafp.org/afp/20041101/contents.html

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Alexandria, Va.: What about supplements for purposes other than weightloss? I've had good success with glucosamine helping with some joint issues (both my own and my dogs') and I've heard that other sugars can help boost the immune system. Is there any evidence to support this? Are there any dietary supplements that you believe are supported by the data?

Robert Saper, MD, MPH: Thank you for this excellent question. It allows me an opportunity to not appear that I am completely against all dietary supplements!

Yes, there is growing promising evidence for the helpfulness of a number of supplements for chronic problems. Notable examples include:

glucosamine sulfate for osteoarthritis

ginkgo biloba for dementia (not the more common age associated memory loss which many of us experience)

saw palmetto for benign prostate hypertrophy

fish oil for elevated triglycerides

soy protein for elevated cholesterol and hot flashes

Some good resources for this are:

www.naturalmedicines.com

www.consumerlab.com

www.naturalstandard.com

www.intelihealth.com

and the NIH National Center for Complementary and Alternative Medicine Web site (www.nccam.nih.gov)

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Columbia, Md.: I've quit smoking for 6 months now. I have already gained 10 pounds without changing my lifestyle or increasing my calories.

I've started walking 1/2 hour several times a week. Is there ANYTHING I can take to slow down the weight gain!

Robert Saper, MD, MPH: Congratulations on quitting smoking!!! Although I know you're unhappy with the weight gain, you should know that the relative health gain statistically and subjectively you receive from quitting cigarettes (dramatic reductions in risk of cardiovascular disease and many cancers) is far greater than any increase potential health complications from the 10 lbs. Having said that, your situation is unfortunately common. Nicotine can suppress appetite some, and I would speculate that your calorie consumption may have actually gone up. Is this possible? Also learn to check you pulse, so that you know when you are walking if you are reaching an aerobic heart rate range. You can estimate your maximum heart rate range by subtracting your age from 225. Your target range should be 60-80% of that.

Ideally for weight loss, 60 minutes of moderate to vigorous exercise is needed.

Good luck!

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Arlington, Va.: Hello, Thanks for taking my question. I exercise at least 30 mins. everyday -- sometimes more. My diet consists mostly of fresh veggies, lean meat and whole grains (make my own bread,etc.), skim dairy (make my own yogurt). By following the volumetrics' way of eating I have lost just over 30 lbs since April. Since September I have hit what appears to be a serious plataeu (I only have about another 5-10 lbs to lose). I feel that my metabolism has slowed from the lower calorie intake (even though I have been exercising religiously) what do you think about the supplement guggulipid? Would it be worth a try? Is it dangerous?

Robert Saper, MD, MPH: Guggulipid has been touted especially for weight loss and high cholesterol. It has not been studied in the former, but yes in the latter with not great results. Some products manufactured in India (it is native to India) have been found to contain heavy metals such as lead.

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Louisville, Ky.: Thank you for doing this chat.

I'd hate to give up (whole wheat) bread and pasta, but I would love to lose 15 pounds. I should take it that no supplement will assist in my goal without me first sacrificing grains?

Robert Saper, MD, MPH: Many people have caught onto the idea that carbs are the enemy. Interestingly a study that compared the Atkins (low carb), Zone (balanced 40,30,30 ratio of pro, carb, fat) and Ornishy (10% fat) all lead to weight loss equally. The key is total calories. Also, if you want to eat bread and pasta, using whole grain sources of both are better. It causes a slower rise in blood sugar, then a slower rise of insulin which may lead to weight loss.

Best,

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Cleveland: DHEA for aiding weight loss? Yes or no.

Robert Saper, MD, MPH: No. Excellent question

DHEA first hasn't been shown to lead to weight loss. More importantly, it is a hormone related to testosterone and we do not know the long range effect of supplementing it on hormone sensitive tissues, eg breast or prostate.

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ludhiana, INDIA: I am 44 year-old-male assigned a computer job. I get an early morning walk for 100 min. a week. MY sugar level is up by 15-20 point above normal every time. Please advise me medicine. I seldom use GLYNASE-MF OD. My body-weight ratio is ok.

Robert Saper, MD, MPH: It is good to hear from you in India. Do you live close to diabetic specialist. I do not know where ludhiana is. Please contact a colleague of mine Dr. V Manohan, an expert diabetologist in India who can refer you to someone in your area. With diabetes the keys are:

Eat and drink foods with no or minimal sugar

Avoid alcohol.

Regular exercise as you are doing.

High fiber diet slows glucose absorption

Often start with a medicine like metformin which reduces insulin resistance, or in combo with glynase is helpful.

Good luck!

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Potomac, Md.: I've been using a variety of hunger suppressants with little or no effect toward long-term maintenance. Are there any supplements that actually make certain high-fat foods taste terrible to the palate? Maybe, if enough of those existed, I could survive on a rabbit diet!

Robert Saper, MD, MPH: Great idea

Not to the best of my knowledge

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Rio de Janeiro, Brazil: What are the side effects of weight loss supplements in the short and longer term?

Thank you

Robert Saper, MD, MPH: Please see my review article that I mentioned earlier. this will provide a more comprehensive answer

Best

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Jacksonville, Fla.: What are those dietary supplements that make you lose weight? Thanks in advance for your response.

Robert Saper, MD, MPH: See previous notes please

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McLean, Va.: The discussion topic is of much interest to me -- more especially the use of alternative medicines.

My question: Can improved liver function help in weight reduction? If yes, do you think that using Ayurvedic medicines can result in success, e.g., a brand product called "Livorest" which is available in India. Also, please suggest any other medicines or alternative products which one can easily obtain in the USA. Many thanks and Cheers.....

Robert Saper, MD, MPH: Not directly. I have not seen literature on Livorest. I do know that a large manufacturer of Ayurvedic products, Himalaya has a branch in the US but I cannot speak to the quality of their products.

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Toronto, Canada: Re Washington's question - in my experience the attraction of supplements is also pure escape from the hard reality of diet and exercise. Every year (so far) I have successfully lost in spring and summer the weight I'm gaining right now. It is nothing less than sweat and being hungry all the time. Where is that magic pill?

Robert Saper, MD, MPH: I agree. There is a tremendous desire for a magic bullet. Our society has become very oriented to quick results from a pill, in large part due to our medical profession and the pharmaceutical industry. If interested, please see a book called "Overdosed America."

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Washington, D.C.: Dear Dr. Saper,

Which supplements actually work to promote weight loss? And how effectively? (Pounds per month if taken correctly.)

Is anyone (Consumer Reports?) checking to see which supplements have the effects they claim to have?

Robert Saper, MD, MPH: Yes, see consumerlab.com; consumer reports has done some studies on supplements - I'm not sure re weight loss supplements

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Formula studies?: Thanks for the synopsis of the breastfeeding/formula feeding study. Perhaps it is not the formula itself, per se, but the fact that breastfed babies learn to stop eating when they are full. Bottle fed babies are permitted to stop eating when that bottle is empty...and often given more. Maybe that's when the cycle is set up for them to lack satiety, feeling forever hungry.

Robert Saper, MD, MPH: That may very well be.

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Rockville, Md.: What do you think of energy drinks for weight loss? Red Bull, Fizzy, Fuze Slenderize... They all seem to have some citrimax supplement, green tea and/or guaranara. Are they safe to drink?

Robert Saper, MD, MPH: All of these contain either caffeine or botanical sources of caffeine. Sometimes the amount of caffeine is equal to 5 times the amount or more of caffeine that is in a cup of coffee. Palpitations, head aches, insomnia, anxiety are all possible complications. I discourage use of these.

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Washington D.C: What fat burning supplement do you think would be most effective for active people?

Robert Saper, MD, MPH: none

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Mechanicsville, Md.: As a former ephedra user, I am extremely cautious with taking supplements now. However, I did achieve great results while using an ephedra-based product. While using the ephedra-based products, I would literally sweat while sitting at my desk. I lost approximately 30 pounds and achieved the body that I had always desired. Now, without the ephedra, I lack the energy to workout as hard, and, to a certain extent, the desire to workout as hard knowing that my results will not be comparable to those I achieve while using ephedra. Is there a product out now that can achieve the same results?

Thank you in advance for your response and advice.

Robert Saper, MD, MPH: Your story is very telling. Thanks for sharing it. I would be cautious about using the new supplements with citrus, bitter orange etc as these cause similar effects.

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Washington, D.C.: I have heard that Omega-3 fatty acids may assist weight loss. Any support to that? If so what Omega-3 sources and dosages are safe?

Robert Saper, MD, MPH: No evidence for weight loss, but these can have substantial health benefits: doses of 1-3 grams per day are usually safe.

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Frederick, Md.: I thank you in advance for answering my question, Dr. Saper.

Can you recommend a vitamin designed specifically for teenagers? My two girls love the gummi vitamins I buy for my 6-year-old son, but they each have to take two a day, which means the supply doesn't last long.

And they hate vitamins for adults.

Does anyone make vitamins specifically for teenagers--great taste, cartoon characters, but with a more adult dosage?

Thanks again!

Robert Saper, MD, MPH: I don't know the answer - great question. I know consumerlab.com has looked at multivitamins. that's where I would look

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Anonymous: I have taken Ephedra on and off for over 10 years. It has been my contention over the years that it is the only supplement that actually works, and the proof of that is the people who take too much and injure themselves.

My point being, there is a certain percentage of the population, especially the young, who will take 2 and 3 times the amount of anything they are taking, just to get extra effect. After a while, any supplement that actually does what it is billed to do is going to hurt someone.

I might have missed it, but I have not seen any instance of ephedra hurting someone who took a responsible dosage and who did not have a pre-existing heart condition of some kind.

This stuff really works to help kill appetite, raise the metabolism, and give energy throughout the day. I bought a bunch before the ban, which I still take.

Am I just an idiot? I am a professional with 3 kids. No heart condition. Why can't I continue to take it?

Thanks for your advice.

Robert Saper, MD, MPH: Thanks. I sympathize, ephedra with caffeine has been probably the only supplement combination to reliable lead to weight loss, but the literature supports the fact that safety concerns outweight this.

Please find the following articles for examples of cases of people without risk factors and taking recommended doses.

Shekelle PG, Hardy ML, Morton SC, Maglione M, Mojica

WA, Suttorp MJ, et al. Efficacy and safety of ephedra

and ephedrine for weight loss and athletic performance:

a meta-analysis. JAMA 2003;289:1537-45.

Haller CA, Benowitz NL. Adverse cardiovascular and

central nervous system events associated with dietary

supplements containing ephedra alkaloids. N Engl J

Med 2000;343:1833-8.

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New York: I have about 5-10 lbs. to lose to get at an ideal weight. Will stimulants like coffee or appetite suppressants help (along with healthy diet and exercise), and what are the risks of taking them? What are the effects of such medication on pregnancy?

Robert Saper, MD, MPH: In pregnancy, it is essential to discuss any medication or supplement use with your doctor. In general, we do not have adequate safety information for any supplements regarding pregnancy and therefore should be discouraged.

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Washington, D.C.: What do you think of Lipovarin?

Robert Saper, MD, MPH: see previous note please

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Adams Morgan, Washington, D.C., but traveling: I want to ask the exact opposite question - what supplements will help weight gain? My elderly father has been losing a lot of weight over the years, but finds it difficult to consume a lot of food. I have been trying to figure out how to increase his calorie consumption without increasing (much) what he eats.

Robert Saper, MD, MPH: Focus on caloric dense foods. I would recommend seeing a nutritionist with him.

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Robert Saper, MD, MPH: I've enjoyed speaking with many of you! I very much apologize for not answering all your questions, but I have to leave now. Best of luck to all of you in your quest for a healthy lifestyle!

Sincerely,

Rob Saper MD MPH

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